ABSTRACT
Progressive supranuclear palsy (PSP) comprises psychiatric, neurological and physical complications. In the late stage, most patients with PSP are bed-bound because of motor disability. PSP manifests as predominantly axial abnormality in posture and abnormal muscle tone, resulting in cervical retroflexion and somatic pains. Severe retroflexion of the neck is frequently a cause of repeated aspiration pneumonia that affects survival expectancy. We injected botulinum toxin (BTX) for severe retroflexion using a CT-guided procedure to confirm the anatomical locations of paravertebral muscles and to localize the paravertebral target muscles for a patient with PSP who had repeated pneumonia caused by retroflexion-related dysphagia. BTX injection treatment markedly ameliorated the cervical dystonia and concomitant dysphagia. The patient has recovered and may be able to be discharged to home. There are few reports on the BTX injection technique, but BTX has analgesic effects and induces relaxation of abnormal muscle tension. Therefore, it may be applicable to other movement disorders at the late stage.
ABSTRACT
<b>Objective: </b>We conducted a questionnaire survey to comprehend the situation regarding the collection, provision, and utilization of drug safety information at hospitals. In addition, we asked pharmaceutical companies how they select medical institutions to provide drug safety information. We also investigated the current situation of information provision to Tokyo Medial Center by pharmaceutical companies.<br><b>Method: </b>A questionnaire was mailed to all hospitals in Japan. The survey was conducted between January 13 and February 10, 2011. Moreover, we asked thirteen pharmaceutical companies by telephone and e-mail about the implementation status of the provision of information and performed a survey at Tokyo Medical Center on the current situation of information provision by pharmaceutical companies regarding revisions to precaution sections in package inserts.<br><b>Results: </b>The results of the questionnaire survey (response rate: 41.2%) showed that the major information sources for hospitals were medical representatives (77.8%), Drug Safety Update (50.3%) and direct mails (49.3%). Furthermore, in the case of drugs prescribed exclusively for extramural dispensing, fewer hospitals responded that medical representatives of the pharmaceutical companies provided drug safety information and more hospitals responded that they did not obtain any drug safety information at all, compared with drugs listed in the hospital formularies.<br><b>Conclusion: </b>To minimize the risks of drugs, healthcare professionals must collect a wide range of drug safety information and must utilize this information in their medical practice. Therefore, it is important that pharmaceutical companies and regulatory authorities make an effort to provide suitable information dissemination to medical institutions. Furthermore, medical institutions must also strengthen their systems for collecting drug safety information and providing such information to healthcare professionals.
ABSTRACT
<b>Background</b>: In terminally ill patients with cancer, sleep disturbance makes worse their quality of life. Midazolam has not ever been used for the treatment of sleep disturbance in general wards of our hospital, used in palliative care unit of other hospital, however. <b>Method</b>: This is a retrospective study based on chart review. Twenty-eight patients who were treated with midazolam for sleep disturbance included in this study. We designed evaluation methods to strictly follow the actual chart descriptions. Efficacy was rated as good, fair, or poor. Safety was defined by the presence or absence of respiratory depression and hypotension. <b>Results</b>: The median administration periods and initial doses were 6 days (range, 1-151) and 5.0 mg/night (1.8-20.0), respectively. Fourteen patients showed good sleep a night after midazolam infusion, four and nine patients showed fair and poor sleep, respectively. No patient demonstrated a respiratory rate of less than 8/min and systolic blood pressure of <60 mmHg at any point during and after midazolam infusion. <b>Conclusion</b>: Intravenous midazolam appeared to be safe for sleep disturbance of terminally ill patients with cancer in general wards. A future improvement administration methods are necessary to treat for sleep disturbance more effectively as well as PCU.
ABSTRACT
<b>Objective</b>: Novel antipsychotic agents less frequently cause extrapyramidal side effects compared to conventional antipsychotic agents, contributing to improvement in the QOL. Recently, these agents have also been increasingly prescribed to females who may become pregnant. In Japan, no epidemiological survey regarding the application of novel antipsychotic agents in pregnant women has been published. In this study, we investigated the influence on fetuses in pregnant women receiving novel antipsychotic agents.<br><b>Methods</b>: In pregnant women on novel antipsychotic agents who consulted the Pregnancy and Drug Consultation Outpatient Clinic of Toranomon Hospital, the outcome of pregnancy was confirmed.<br><b>Results</b>: Twenty-nine pregnant women took novel antipsychotic agents in the organogenesis phase, in which the risk of teratogenicity is the highest. The agents consisted of olanzapine in 8 patients, risperidone in 11, quetiapine fumarate in 7, and perospirone hydrochloride hydrate in 4. The outcomes of pregnancy were full-term delivery in 24 patients, premature delivery in 1, spontaneous abortion in 2, and artificial abortion in 2. Of the 29 patients, 15 (60%) had continuously taken these agents until delivery. All 25 neonates were healthy without malformation.<br><b>Conclusion</b>: This report describes the first prospective survey in Japan regarding infants delivered by pregnant women receiving novel antipsychotic agents. All patients delivered healthy neonates; the incidence of congenital anomalies did not exceed that in the general population. This survey included a small number of patients; cohort studies should be conducted to evaluate the safety in fetuses.
ABSTRACT
<b>Objective</b>: Treatment of tinea unguium with topical drugs alone is difficult, and medication with oral terbinafine hydrochloride is necessary in many cases. Since Trychophyton infects the nails in not only men but also women at a reproductive age, the influence on a fetus of the drug ingested during early pregnancy is a matter of concern of many women. The objective of this study was to investigate the influence of oral terbinafine hydrochloride on fetuses.<br><b>Methods</b>: The outcomes were investigated in pregnant women who ingested terbinafine hydrochloride and visited the ‘Outpatient Services for Consultation on Pregnancy and Drugs (Teratology Information Services)’ of Toranomon Hospital, and cases were collected.<br><b>Results</b>: Fifteen pregnant women ingested the drug during the organogenic period, in which the teratogenic risk is the highest. All 15 pregnant women gave birth to healthy babies.<br><b>Conclusion</b>: This is the first survey concerning newborns delivered by women who ingested terbinafine hydrochloride during pregnancy in Japan. All investigated women gave birth to healthy babies, and the incidence of congenital abnormalities did not markedly exceed that in the general population. Since the number of cases was small, it is necessary to perform a cohort study to investigate details of the safety for fetuses.